May 21, 2024

New AAP Guidelines Allow HIV-Positive Mothers to Breastfeed

People with HIV can now breastfeed their babies if they are taking medications that effectively suppress the virus, according to a new policy by the American Academy of Pediatrics (AAP). This marks a significant change from the guidelines that had been in place since the HIV epidemic began in the 1980s.

The updated AAP report acknowledges that antiretroviral therapy can reduce the risk of HIV transmission via breast milk to less than 1%. Dr. Lisa Abuogi, a pediatric HIV expert at the University of Colorado and lead author of the report, emphasized the importance of shared decision-making due to the effectiveness of these medications and the substantial benefits of breastfeeding for both mother and baby.

While these medications significantly reduce the risk, they do not completely eliminate it. Therefore, avoiding breastfeeding remains the only sure way to prevent HIV transmission through breast milk. Additionally, it is crucial for parents to exclusively breastfeed for the first six months, as alternating between breast milk and formula can increase the risk of HIV infection by disrupting the infant's gut.

Approximately 5,000 people with HIV give birth annually in the U.S., with nearly all on medication to suppress the virus. However, if these medications are not consistently taken, viral levels can rise. Before the availability of these drugs, about 30% of mother-to-child HIV transmissions occurred during breastfeeding, resulting in roughly 2,000 infant infections each year in the early 1990s. Today, this number has decreased to fewer than 30 annually.

The AAP's policy change follows updates from the National Institutes of Health and the Centers for Disease Control and Prevention, which also recently reversed their longstanding recommendations against breastfeeding for people with HIV. The new guidance advocates for counseling individuals with consistent viral suppression on their breastfeeding options and advises healthcare providers not to alert child protective services if a parent with HIV chooses to breastfeed.

Dr. Lynn Yee, a Northwestern University professor who contributed to the NIH guidance, highlighted the importance of listening to and supporting patients without judgment. Research shows that breastfeeding offers ideal nutrition for babies and protection against various illnesses and conditions. It also reduces mothers' risks of developing certain cancers, diabetes, and high blood pressure.

Since 2010, the World Health Organization has recommended that women with HIV in developing countries breastfeed their infants if they have access to antiretroviral therapy. This recommendation balances the risk of HIV transmission against the dangers of malnutrition and infection in regions where safe alternatives to breast milk are unavailable.

In developed countries, where safe water, formula, and donor milk are readily available, experts had traditionally advised against breastfeeding. This stance frustrated many people with HIV, who were denied the option to nurse their children.

Ci Ci Covin, a 36-year-old from Philadelphia diagnosed with HIV at 20, was not allowed to breastfeed her first child, leading to postpartum depression. However, with her second child, she successfully breastfed for seven months with the support of her healthcare team and adherence to her medication regimen.

Abuogi noted that the AAP report provides essential guidance for pediatricians, nurses, and lactation specialists. Some healthcare providers were already supporting HIV-positive parents in breastfeeding despite previous recommendations, and the new guidelines aim to broaden this support.

"This shift is driven not only by healthcare providers but also by the patients themselves," Abuogi said.